1
Q
What life threatening disorder usually develops after the 20th week of pregnancy
A
Hypertension
2
Q
gestational HTN
A
*140/90 +
-WITHOUT proteinuria or other s/s of preeclampsia
3
Q
Preeclampsia
A
*this is the nonconvulsive form of disorder
-high BP after 20 wks gestation
-WITH proteinuria in a previous normotensive woman
*140/90+ or severe is 160/110+
4
Q
preeclampsia/eclampsia findings
A
*BP >140/90
or
*30 mmHg systolic and 15 mmHg diastolic over baseline on 2 occasions w/ 4-6 hrs between
-gen edema (5lbs+/week)
-20-24th wk gestation
-disappears w/in 42 days after delivery
5
Q
pre/eclampsia RF
A
-under 19/primiparas
-over 35
6
Q
eclampsia incidence increases in who?
A
-primiparas
-multiple fetuses
-hx of vascular disease
7
Q
labs with preeclampsia/eclampsia
A
-low H/H
-increased blood urea nitrogen
-increase creatinine
-increases uric levels
-liver enzymes & P/C ratio> 0.3 mg/dl
8
Q
preeclampsia/eclampsia s/s
A
*systemic peripheral vasospasms that effect EVERY organ system
-LATE DECELS
-HEADACHE
-blind spots (scotoma: blurry vision)
-Hyperrflexia
-nausea/vomiting
-irritability
-epigastric pain
-edema
9
Q
Eclampsia
A
*HTN causing seizures from preeclampsia
10
Q
first signs of preeclampsia/eclamp
A
-tingly hands/fingers
-sudden weight gain
11
Q
what patients are at risk for HELLP
A
preeclampsia pts
12
Q
pt w/ pre/eclampsia will complain of?
A
-HEADACHE
-blurry vision
-hyperreflexia
-n/v
-edema
-irritability
-*epigastric pain**
13
Q
Deep tendon reflex +4
A
*abnormal
-hyperactive
-very brisk
-jerky
-clonic response
14
Q
Deep tendon reflex +3
A
*may not be abnormal
-brisker than average
15
Q
Deep tendon reflex +2
A
*normal
-average response
16
Q
Deep tendon reflex +1
A
*low normal
-diminished response
17
Q
Deep tendon reflex 0
A
*Abnormal
-no response
18
Q
Possible complications with pre/eclampsia
A
-seizures–>eclampsia
-intracranial hemorrhage
-Heart failure
19
Q
why might it be hard to dx chronic HTN w/ superimposed preeclampsia or eclampsia
A
-can be difficult if pt has renal disease that also causes proteinuria
*they can have a rise in uric acid in late 2nd or early 3rd trimester
20
Q
HELLP Syndrome
A
*life threatening variant of preeclampsia involving changes in blood components and hepatic dysfunction:
21
Q
HELLP stands for?
A
H: Hemolysis (RBCs fragmented/irregular)
E/L: Elevated liver enzymes (AST,ALT)
L/P: Low platelets (<100,000)
22
Q
what patients are at risk for HELLP
A
preeclampsia pts
23
Q
Labs with HELLP
A
After birth they will go back to normal within 1 week
24
Q
severe complications of eclampsia
A
-cerebral edema
-stroke
-abruptio placentae w/ or w/o DIC
-fetal death
25
Managing pre/eclampsia
*magnesium sulfate
-antihypertensive (procardia/hydralazine/labetalol)
-bed rest
-QUIET DARK ROOM
-strict I/Os
-High protein/low salt diet
-seizure precautions
*must have emergency resuscitation equipment
26
what is the goal of magnesium sulfate
prevent seizures in pre/eclamp pts
27
how does Mg Sulfate effect baby
baby will be flaccid at birth
28
what is the most important thing before giving magnesium sulfate
make sure urine output is more than 30 ml an hour and kidneys are functioning
29
MgSo4 administration
*IV
-loading dose 4-6 gm over 15-30 min
then
-maintenance dose infusion of 1-2g/hr
*after delivery:
-access baby for mag effects
-continue mag up to 12-24 hrs
30
s/s of MgSO4 toxicity
*decreased:
-RR
-Renal function
-DTRS (patellar reflex but if has epiderual check bicep/tricep reflex)
-LOC (CNS depression)
*muscle weakness/flaccidity
31
Contraindications of MgSO4
-myasthenia gravis
-severel renal failure
-cardiac ischemia
-heart block
-pulmonary edema
-high mag lvl
-low calcium lvl
32
MgSO4 toxicity guidelines
*administer IVPB
-monitor serum Mg levels-baseline level before treatment and q6hrs
(check hospital policy)
33
antidote for MgSO4
CALCIUM GLUCONATE
34
HELLP assessment findings
*RUQ/epigastric/lower chest pain
-distended liver (liver may rupture)
-N/V
-gen malaise
-severe edema
-s/s preeclampsia
35
Complications of HELLP
*fetal/maternal death
-liver rupture-->hematoma
-hemorrhage
-hypoglycemia
-renal failure
-DIC
36
HELLP managment
*IMMEDIATE DELIVERY (vag or c/s)
-ICU for baby/mom
-MgSO4
-Transfusion of FFP/platelets (to reverse thrombocytopenia)
37
HELLP interventions
*DONT PALPATE ABDOMEN--> could rupture liver hematoma
-quiet/dim room
-seizure precautions
-Maternal VS/FHR
38
Bleeding precautions w/ HELLP
*risk for bleeding d/t thrombocytopenia
-monitor s/s bleeding
-administer transfusions/meds
-prep pt for delivery
-assess thru l/d for hemorrhage
-check hypoglycemia
39
if HELLP pt is hypoglycemic, what do you do
administer IV dextrose solutions
40
When is DM considered GDM
When pregnant women never dx w/ DM shows glucose intolerance
41
GDM findings
-hyperglycemia
-glycosuria
-polyuria
42
GDM risk factors
-obesity
-hx of large baby
-HTN
-Glucosuria
-unexplained fetal/perinatal loss
-congential anomilies in previous pregnancies
-over age of 40
-fam hx of DM
43
GDM complications
*30-40% chance of DM in 1-25 yrs
TYPE 1:
-congenital anomalies
-hydramnios
-macrosomina
-GHTN
-SAB
-fetal death
-sacral agenesis
44
GDM screening methods
*all women 24-28 weeks at risk will get:
-ORAL GLUCOSE TOLERANCE TEST (OGTT)
-random BS checks/urine checks for ketons/sugar
45
GDM screening test process
*1 hr glucose test nonfasting :
-lvl >130-140 mg/dl requires further testing--> 3 hr fasting glucose test
*3 hr fasting glucose test:
-GDM is dx if 2 levels are met/exceeded
46
goal for fasting blood sugar level for GDM
less than 100mg
47
what GDM tx is contraindicated in pregnancy
*oral anti-diabetic meds
(can give in 2nd/3rd trimester IF they are not complying w/ insulin regimen)
48
insulin requirements thru pregnancy
-insulin decreases during 1st trimester
-insulin increases in 2nd/3rd trimester
49
GDM fetal assessment
-fetal activity monitoring
-NST (at 28wks)
-BPP
-US at 18 and 28 wks
-fetal growth parameters
50
Premature labor aka preterm labor (PTL) is defined by what?
*onset of rhythmic contractions that make cervix change after fetal viability but before fetal maturity
-20-37 GA
-prognosis depends on birth weight
-increases risk of neonate morbidity/mortality
51
PTL maternal causes
-CVD or renal disease
-DM
-GHTN
-infection
-abd surgery/trauma
-incompetent cervix
-placental abnormalities
-PROM
*LOOK AT MOMS JOB
52
PTL fetal causes
-infection
-hydramnios
-multiple pregnancy
53
s/s of multiple gestation
-increase fundal height
-quickening in different areas
54
criteria for PTL
-contractions q5 min for 20 min
OR
-8 contractions in a 60 min period AND cervix change or cervical effacement of 80%+
OR
cervical dilation greater than 1 cm
55
Meds for PTL
-Terbetuline
-MgSO4
-Indomethacin
-Nifedipine
56
terbutaline for PTL
*brethine
-Tocolytic: stops/slows down labor-->relaxing the uterus-->stops contractions
-causes smooth muscle relaxation
57
Terbutaline contraindications
-severe gHTN
-Cardiac disease
58
what adverse effect can terbutaline cause?
tachycardia (tachysystole) in mom and fetus
59
antidote for terbutaline
*PROPANOLOL
-given for cardiac tachysystole
60
MgSO4 for PTL
*CNS depressant--> RELAXES uterus
-also used to stop seizures in eclampsia
61
MgSO4 contraindications (PTL)
-abd pain
-oliguria
62
MgSO4 adverse effects (PTL)
-drowsiness
-n/v
-blurred vision
63
What is the first drug used to halt contractions
MgSO4
64
Indomethacin for PTL
(indocin)
*synthesis inhibitor--> STOPS prostaglandins from causing contractions
65
why cant you give indomethacin after 32 weeks?
can cause premature closure of ductus arteriosus
66
indomethacin contraindications
-GI bleed
-Ulcers
-Rectal bleeding
-Severe cardiac disease
67
other for PTL what can you give indomethacin for?
for polyhydramnios to stop urine production
68
Nifedipine for PTL
(procardia)
*calcium channel blocker-->relaxes uterus by stopping calcium from making muscles contract
69
nifedipine contraindications (PTL)
-AV heart block
-systolic BP <90mmHg
70
nifedipine adverse effects
-HA
-dizziness
-flushing
71
antidote for nifedipine
NONE
72
before you give nifedipine, what do you need to do
Check BP and HR
73
PTL interventions
*ALWAYS think fetal lung maturity--> betemethasone
-s/s of mom/baby distress
-monitor ctx and notify PCP if occur more than 6-8x/hr
-lie pt on side--> prevents vena cava syndrome, supine hypotension, fetal hypoxia
-limit activities/lifting (check work)
-no sex
74
premature rupture of membranes (PROM)
*spontaneous break in amniotic sac before true labor
-membrane ruptures 1+ hrs before onset of ctx
*NOT IN LABOR BUT TERM
75
PPROM
*preterm premature rupture of membranes
-ruptures in preterm gestation
*NOT IN LABOR AND PRETERM
76
PPPROM
prolonged preterm premature ROM
*NOT IN LABOR, PRETERM, BEEN A WHILE (+18HRS)
77
maternal risk (PROM)
-chorioamnioitis (If ROM >24hrs)
-maternal fever
-fetal tachycardia
-foul smelling discharge
78
PROM fetal risk
-infection
-sepsis
-perinatal mortality
79
PROM findings
-blood tinged amniotic fluid
-maternal fever
-fetal tachycardia
-foul smelling discharge
-alkaline pH of fluid collected
-ferning of fluid on slide
80
PROM is caused by?
Unknown
81
TX for PROM
*tx is based on FETAL AGE and risk for infection:
-delivery vs bed rest and antibiotics
-give steroids IM
82
PROM interventions
-explain dx test
-assist w/ examination/specimen collection
-administer IV fluids
-observe for initiation of labor
-offer emotional support
83
Prolapsed umbilical cord
*EMERGENCY--> needs prompt action to save fetus: cord may become compressed between fetus and cervix/pelvis
-descent of cord into vagina before presenting part
84
Anytime there is ROM what should you check for?
prolapsed umbilical cord
85
When dealing with prolapsed umbilical cord during labor, what must you do?
MUST continuously lift head w/ sterile gloves
86
what can cause prolapsed umbilical cord
-PROM
-presentation other than cephalic
-placenta previa
-small fetus
-CPD
-hydramnios
-multiple gestations
-anyf actor that interferes w/ descent
87
Prolapsed umbilical cord interventions
1. *CONTINUOUSLY lift fetal head off cord w/ sterile glove
2. pt placed in knee chest or trendelenburg--> relieves pressure on cord
3. O2
4. monitor FHR
5. saline soaked sterile dressings over exposed cord
6. urgent or crush c/s
88
what kind of FHR for prolapsed cord
prolonged decels
89
PRIORITY after ROM to determine possible cord prolapse
Monitor FHR
90
Shoulder dystocia
*MEDICAL EMERGENCY
-occurs after delivery of the fetal head-->baby anterior shoulder stuck behind pubic bone--> baby does not follow the delivery of the head
91
what is the turtle sign for shoulder dystocia
bby's head will pop out but will go back into birth canal
92
interventions for shoulder dystocia
-lower head of bed
-McRoberts position (legs up and back towards chest)
-suprapubic pressure
-emergency delivery if maneuvers unsuccessful
93
multiple gestations s/s
-increase in uterus size at faster rate
-quickening at different areas
-more fetal activity than normal
-multiple FHTs
-increased fatigue/backache
-elevated msAFP
-multiple amniotic sacs
94
multiple gestation complications
-gHTN
-hydramnios
-PP
-PTL
-anemia
-PP bleeding
-velamatous cord insertion
-twin-to-twin transfusion
95
Uterine inversion
uterus turns inside out and protrudes into vagina
96
what causes uterine inversion
-too much tractions applied to the cord in attempt to deliver placenta
-excessive pressure on fundus during delivery of placenta when the uterus is not contracted
-abnormally adherent placenta (placenta accreta)
97
uterine inversion findings
-large/sudden gush of blood
-non-palpable fundus
-s/s of shock
-severe blood loss
98
uterine inversion tx
-replace the uterus by the MD
-IV/blood products
-meds to relax uterus (tocolytic, gen anesthesia, nitroglycerin)
-oxytocin may be used to promote contraction
-abx
-emergency hysterectomy (LAST RESORT)
99
Uterine rupture
*spontaneous tearing of uterus--> fetus expelled into peritoneal cavity
-from uterus enduring more strain than capable of handing
100
uterine rupture risks
-previous C/S (especially w/ classical incision)
-hysterectomy repair
-prolonged labor
-baby malpresentation
-multiple gestations
-use of oxytocin
-traumatic maneuvers using forceps or traction
101
uterine rupture findings
*CHANGE in abdominal contour (indentation across abd over the uterus)
*-report of tearing sensation
*-cessation of ctx
*-absent FHR
-strong ctx w/o dilation
-sudden/severe pain
-hemorrhage
-shock
102
uterine rupture tx
-emergency delivery of fetus
-emergency surgical repair
-fluid replacement
-possible hysterectomy
-advise pt to not conceive again after rupture
103
uterine rupture interventions
-assist w/ emergency delivery/surgery
-fluid replacement
-offer emotional support and info
104
Sickle Cell Anemia Management
*recessive autosomal DO--> RBCs are sickle shaped*
-hydrate
-pain control
105
what to know about drug test with sickle cell
may test positive
106
folic acid deficiency anemia
*not uncommon
-slowly progressive enlarged RBCs
107
Iron Deficiency anemia
*DO of O2 transport in which HgB is deficient
108
What type of anemia is most common during pregnancy
*Iron deficiency
-associated w/ low brith weight and preterm birth
109
Iron deficiency tx
Iron (ferrous sulfate) 300 mg 1x PO
110
What should you take with Ferrous sulfate
ORANGE JUICE
111
how do you treat severe iron deficiency anemia
iron transfusion
112
What is important to know about the work load of the heart?
the more blood volume = more work on the heart
113
Congenital cardiac diseases
*atrial septal defect
-ventricular septal defect
-pulmonary stenosis
-coarctation of the aorta
114
Rheumatic cardiac disease
endocarditis--> scar tissue on valves
115
Mitral valve prolapse might need what meds?
prophylactic abx
116
How to manage cardiac diseases
-activity limit
-close medical superivison
-rest
-limit sodium
-prophylactic abx
117
Possible complications w/ cardiac diseases
-IUGR
-fetal distress
-premature birth
-CS
118
What is cholestasis
liver disease--> bile build up in liver/bloodstream
119
bile does what
*lipid-rich solution from liver, stored in gall bladder--> aids in fat digestion
120
Intrahepatic cholestasis of pregnancy OR obstetric cholestasis
*hormonally induced (estrogen/progesterone)
-3rd trimester
-subsequent pregnancies
121
Obstetric cholestasis s/s
-*generalized itching
-dark urine
-jaundice
-elevated serum bile acids
-elevated liver transaminases
122
cholestasis fetal risk
-PTL
-passage of meconium
-asphyxia/resp distress
-fetal loss
123
cholestasis tx
*Ursodiol 300 mg BID PO
-early delivery
124
substance abuse complications
-risk of infection
-cellulitis
-FAS
-NAS
125
Depressant (alcohol) effects
-microcephaly
-FAS
-IUGR
126
Narcotics (heroine/methadone) effects
-severe WD
-NAS
127
Barbiturates (phenobarb) effects
-severe WD
-FGR
128
tranquilizers (diazepam) effects
WD s/s
129
stimulants (meth/coke) effects
-low birth weight
-SIDS
-SAB
130
anti-anxiety (lithium) effects
congenital abnormalities
131
Psychotropic (pcp angel dust) effects
-WD s/s
-behavioral/developmental abnormalities
132
Marijuana effects
possible structural and neurobehavioral defects
133
STI management
-pharm therapy
-safe sex
-tx of partner
134
STI complications
-PTL
-PROM
-neonatal conjuctivitis or pneumonia (chlamydia)
-congenital herpes
-opthalmia neonatorum
-RDS
135
HIV contracted via
-across placenta
-L&D
-breast milk
136
HIV management
*combo of antiretroviral (zidovudine) therapy
137
amniotic fluid embolism
*EMERGENCY (high risk of maternal mortality)
escape of AF into maternal circulation (ANAPHYLACTOID type of response)
138
what causes AF embolism
defect in membranes after ROM or abruption
139
predisposing factors for AF Embolism
-IUFD
-High parity
-abruption
-oxytocin
-AMA
140
AF Embolism findings
*SUDDEN DYSPNEA
*CHEST PAIN
-cyanosis
-tachypnea
-hemorrhage
-coughing with pink/frothy sputum
-restless/anxiety
-shock disproportionate to blood loss
141
AF Embolism tx
*IMMEDIATELY deliver
-give O2
-give blood
-give heparin
-insert central venous pressure line
-monitor cardiopulmonary status
142
AFEmbolism interventions
-O2 via face mask
-assess VS q15 min
-prepare for CPR
-prep for immediate c/s
-assess for s/s of DIC
143
Cephalopelvic disproportion
*narrowing of canal --> failure to progress--> bby's head does not engage
144
CPD causes
-small pelvis
-inlet contraction (narrow of anteroposterior diameter: TOP PART)
-outlet contraction (narrow of transverse diameter: LOWER PART)
-Large fetal size
-Abnormal position of head
-malpresentation
145
BIGGEST takeaway from cpd
labor fails to progress
146
If ROM happens in CPD then?
cord may prolapse
147
CPD tx
*MD may allow labor trial
-vag delivery if progress
-C/S if complciations
148
Placental anomalies
abnormalities in size of placenta
OR
in blood vessels connected to it
149
causes of placental anomalies
*unknown (usually large placenta)
-DM can have large placenta
-Syphilis can have large placenta
-uterine scars may contribute
150
Placental anomalies tx
-visual inspection after birth
-tx is based on type of anomaly
151
placental anom interventions
-inspect placenta
-assist w/ removal
-monitor PP period
152
placenta acreeta
*placenta deeply attached to the uterine wall
-may need methotrexate to destroy remaining tissue
153
Perinatal loss/still birth
death from time of conception through the end of newborn period (28 days after birth)
154
Intrauterine fetal death (IUFD)
death after 20 wks gestation
155
stillbirth RF
-obesity
-race/ethnicity
-age
-multiple gestations
-nulliparas highest risk
-early dx of congenital anomalies
-IVF
-Amniocentesis/CVS
156
still birth medical RF
-htn
-dm
-thyroid, renal, liver disease
-connect tissue disease like lupus
-cholestasis
-feto-maternal hemorrhage
-fetal growth restriction
-placental abnormalities
-antiphospholipid syndrome
-umbilical cord pathology
-multiple gestation
-amniotic band sequence
157
still birth maternal implications
-prolonged retention of dead fetus--> DIC
-needs immediate induction
158
if stillbirth happens with multiple gestation then what?
conduct routine maternal clotting studies
159
stillbirth TX
*misoprostol 200-400 mcg vaginally q4-12 hrs used if under 28 wks
-induce w/in 2 days of dx
-if had previous low c/s-->foley bulb induction
160
Intrapartum care
*period of care received during labor and delivery or childbirth
begins with onset of labor and ends at competition of 4th stage
161
The 5 P's of Labor
-Passage (pelvis/birth canal)
-Passenger (fetus)
-Power (physiologic force of labor)
-Position (maternal positioning in labor)
-Psyche
162
If components of the 5 P's of labor are altered, the outcome of labor can be adversely affected, leading to:
-C/S
-assisted vaginal delivery (forceps or vacuum)
162
Passage
*route that the baby must use when leaving the uterus, arriving at the external perineal area for birth
-includes maternal pelvis and soft tissues
162
Important to check passage for?
if maternal pelvis must be of adequate size for the fetus to pass (NO CPD)
163
Passage (Pelvis Shapes)
-gynecoid
-android
-anthropoid
-platypelloid
164
Gynecoid shape
*BEST ONE + most common (around 50% females)
-round shape w/ adequate diameters to allow (fat heart)
164
Android Shape
*occurs in 20%
-heart shaped, norm male pelvis
-diameter is kinda narrowed-->difficult fetal passage
165
Anthropoid shape
*25% of females (HARDEST TO GIVE BIRTH WITH)
-oval with longer anteroposterior diameter
-may be difficult passage except when baby in an occiput posterior position
165
Platypelloid
*5% of females (COMPACT)
-oval or flat
-might be difficult for bby to rotate to match shape of pelvis at appropriate diameter
166
Passenger components
-Fetal skull
-presentation
-Lie
-Attitude
-Position
-Station
167
fetal skull passanger
size is important
168
presentation passanger
bby body part that first passes through the cervix to be delivered
169
attitude passenger
relationship of bby body parts to one another
170
Lie Passenger
relationship of spine of fetus to spine of mom
171
position passenger
relation of presenting part of baby to specific section of moms pelvis
172
station passenger
relation of presenting part of baby to the ischial spines of moms pelvis
173
what part of the skull is the smallest/best part to come out first?
occiput
174
presentation 3 categories
1. cephalic
2. breech
3. shoulder
175
vertex cephalic
parietal bones/space between fontanels presents first
176
brow cephalic
head mod flexed, brow enters first
177
face cephalic
poorly flexed-->face presents first
178
mentum cephalic
chin presents first
179
complete breech
-thighs tightly flexed
-criss-cross
-cant be vag delivery
180
frank breech
fetal hips flexed, legs extended and resting on chest
181
footling breech
1+ feet point down and deliver before body
*MOST DIFFICULT OF BREECHES
182
shoulder presentation
-shoulder, scapula, hand, or elbow presents first
-lying horizontal in pelvis
REQUIRES:
-early dx/intervention
-fetus may turn before delivery
-C/S is almost ALWAYS needed
(Mom may have distorted shape)
183
nursing
flashcards
Decks in class (15)
# Cards
-
Ob exam 2 fetal wellbeing244
-
Leadership exam 125
-
OB pregnancy risk part 1 (exam 2)68
-
OB Final187
-
Leadership exam 289
-
Peds exam 1157
-
peds exam 2158
-
Leadership exam 3152
-
Peds exam 3128
-
peds exam 480
-
peds exam 5 musculoskeletal41
-
peds ati71
-
complex exam 1224
-
complex study guide filled56
-
Complex exam 299
